Company Details

Please complete all sections of this form. Important Restrictions and Limitations of Cover are indicated in Blue text. Please make sure you have read and understood these notes fully.

Full Company Name:

Subsiduary Names:

ABN Number
GST Registered
Are You GST Registered?

Director´s Name(1)
Director´s Name(2)

Director´s Name(3)
Director´s Name(4)

Business Address:

State
Post Code
Contact
Position

Telephone Number:
Mobile Number:

Email:

Website Address:

Postal Address:

Business Type
Description(Other)

Date Established:
        
Date Elsewhere:
   
Business Status
Status(Other)

Business Activity:

Which Certifying Association Standards does the School/Centre train to?
What types of locations are used for instruction/training, and to what maximum depth?

Locations/Depths

Please provide a breakdown of the total turnover of your business as follows:

Diver Training $
Repairs & Servicing $

Retail Sales $
Other Turnover $

Other Turnover:

Please provide the total number of:

Dive Instructors
Annual Wages $

Assistant Instructors/Dive Guides
Annual Wages $

Non-Diving Staff
Annual Wages $

Volunteers

Qualifications & diving practices of Instructors / Assistant Instructors / Dive Guides must comply with National/Local regulations & any other Statutory Regulations, in addition to their certifying Association's recommendations for safe Diving Practice